Sample Size Requirements for Calibrated Approximate Credible Intervals for Proportions in Clinical Trials

In Bayesian analysis of clinical trials data, credible intervals are widely used for inference on unknown parameters of interest, such as treatment effects or differences in treatments effects. Highest Posterior Density (HPD) sets are often used because they guarantee the shortest length. In most of standard problems, closed-form expressions for exact HPD intervals do not exist, but they are available for intervals based on the normal approximation of the posterior distribution. For small sample sizes, approximate intervals may be not calibrated in terms of posterior probability, but for increasing sample sizes their posterior probability tends to the correct credible level and they become closer and closer to exact sets. The article proposes a predictive analysis to select appropriate sample sizes needed to have approximate intervals calibrated at a pre-specified level. Examples are given for interval estimation of proportions and log-odds

Bayesian Set Estimation with Alternative Loss Functions: Optimality and Regret Analysis

Decision-theoretic interval estimation requires the use of loss functions that, typically, take into account the size and the coverage of the sets. We here consider the class of monotone loss functions that, under quite general conditions, guarantee Bayesian optimality of highest posterior probability sets. We focus on three specific families of monotone losses, namely the linear, the exponential and the rational losses whose difference consists in the way the sizes of the sets are penalized. Within the standard yet important set-up of a normal model we propose: 1) an optimality analysis, to compare the solutions yielded by the alternative classes of losses; 2) a regret analysis, to evaluate the additional loss of standard non-optimal intervals of fixed credibility. The article uses an application to a clinical trial as an illustrative example

Digital Well-Being as a New Kind of Adaptation to the New Millennium Needs: A State-of-the-Art Analysis

AbstractSince technology has been entering into human beings’ everyday life, individuals established a deep relationship with digital technology, thus an embodied link between people and digital instruments has been born. This is particularly evidenced by recent literature about screen time (duration of time spent by the individual in using electronic/digital media like television, smartphone, tablet or computer), it significantly influences different human beings’ dimensions: physical, psychological and neurological functions. Impact of digital technology on human beings can be considered as a result of syntonic functioning in order to improve different people’s life areas (e.g., work, social or intimate relationship, learning), while the dystonic relationship is evidenced as a result of human addiction to digital technology. The present study aims to provide a cognitive and social psychology perspective on how screen time is changing our existences, defining digital technology as a gift which people should be aware of in terms of positive but even negative consequences in everyday life

On the predictive performance of a non-optimal action in hypothesis testing

In Bayesian decision theory, the performance of an action is measured by its pos- terior expected loss. In some cases it may be convenient/necessary to use a non- optimal decision instead of the optimal one. In these cases it is important to quantify the additional loss we incur and evaluate whether to use the non-optimal decision or not. In this article we study the predictive probability distribution of a relative measure of the additional loss and its use to define sample size determination criteria in a general testing set-up

Marked efficacy of Rituximab in multifocal motor neuropathy associated with chronic lymphocytic leukemia

The authors describe a patient who presented a multifocal motor neuropathy (MMN) associated with a high anti-ganglioside antibody (anti-GM1 and anti-GD1) titer at the clinical onset of a B-cell chronic lymphocytic leukemia (B-CLL). Immunomodulation (IVIg plus cyclosporine) resulted in a neurological improvement and reduced anti-ganglioside antibody titers, both of which remained stable for at least six years. After this period, the patient had a severe relapse of the neuropathy, which was independent of the clinical course of the B-CLL. Both IVIg and cyclophosphamide were ineffective, and the patient became tetraplegic within six months; in the meantime, the patient displayed an increased antiganglioside antibody titer. Treatment with rituximab (RTX), which is designed to selectively inhibit B cell function, resulted in a dramatic, prompt and long-lasting neurological improvement as well as a reduced anti-ganglioside antibody titer. Although there are no previous reports of MMN in patients with B-CLL, the efficacy of RTX in the treatment of MMN in this patient may be considered remarkable. The expansion of B-cell clones may be a prerequisite for RTX effectiveness in MMN, and in dysimmune neuropathies in general

Marked efficacy of rituximab in multifocal motor neuropathy associated with chronic lymphocytic leukemia

The authors describe a patient who presented a multifocal motor neuropathy (MMN) associated with a high anti-ganglioside antibody (anti-GM1 and anti-GD1) titer at the clinical onset of a B-cell chronic lymphocytic leukemia (B-CLL). Immunomodulation (IVIg plus cyclosporine) resulted in a neurological improvement and reduced anti-ganglioside antibody titers, both of which remained stable for at least six years. After this period, the patient had a severe relapse of the neuropathy, which was independent of the clinical course of the B-CLL. Both IVIg and cyclophosphamide were ineffective, and the patient became tetraplegic within six months; in the meantime, the patient displayed an increased antiganglioside antibody titer. Treatment with rituximab (RTX), which is designed to selectively inhibit B cell function, resulted in a dramatic, prompt and long-lasting neurological improvement as well as a reduced antiganglioside antibody titer. Although there are no previous reports of MMN in patients with B-CLL, the eficacy of RTX in the treatment of MMN in this patient may be considered remarkable. The expansion of B-cell clones may be a prerequisite for RTX effectiveness in MMN, and in dysimmune neuropathies in general

Mechanisms of altered bone remodeling in children with type 1 diabetes

Bone loss associated with type 1 diabetes mellitus (T1DM) begins at the onset of the disease, already in childhood, determining a lower bone mass peak and hence a greater risk of osteoporosis and fractures later in life. The mechanisms underlying diabetic bone fragility are not yet completely understood. Hyperglycemia and insulin deficiency can affect the bone cells functions, as well as the bone marrow fat, thus impairing the bone strength, geometry, and microarchitecture. Several factors, like insulin and growth hormone/insulin-like growth factor 1, can control bone marrow mesenchymal stem cell commitment, and the receptor activator of nuclear factor-kappa B ligand/osteoprotegerin and Wnt-b catenin pathways can impair bone turnover. Some myokines may have a key role in regulating metabolic control and improving bone mass in T1DM subjects. The aim of this review is to provide an overview of the current knowledge of the mechanisms underlying altered bone remodeling in children affected by T1DM

Determination of Commercial Animal and Vegetable Milks’ Lipid Profile and Its Correlation with Cell Viability and Antioxidant Activity on Human Intestinal Caco-2 Cells

none9openantonella aresta; Stefania De Santis; Alessia Carocci; Alexia Barbarossa; Andrea Ragusa; Nicoletta De Vietro; Maria Lisa Clodoveo; Filomena Corbo; Carlo ZAMBONINAresta, Antonella; De Santis, Stefania; Carocci, Alessia; Barbarossa, Alexia; Ragusa, Andrea; De Vietro, Nicoletta; Lisa Clodoveo, Maria; Corbo, Filomena; Zambonin, Carl

Approccio del Fisioterapista nella presa in carico del paziente con lombalgia cronica: indagine esplorativa presso l'AziendA USL di Reggio Emilia

Background: Chronic Low Back Pain (CLBP) is currently considered a biopsychosocial syndrome, where individual, physical, occupational, psychological and social risk factors coexist. The available research indicates that physiotherapists (PTs) theoretically endorse the proposed biopsychosocial approach to treatment, yet very few are adopting this approach in clinical practice. Aim: The purpose of this exploratory survey is to obtain a detailed view of physiotherapists’ perceptions in their local setting, with specific reference to the operators’ kind of approach and professional skills in the treatment of CLBP. Methods: The survey tool was a focus group, based on a simulated clinical case conducted with expert operators selected on a voluntary basis. The results of the interview were analyzed using a qualitative-inductive method. Results: The analysis shows results related to three interconnected macro areas: the physiotherapists’ professional skills/training, evaluation tools, and organizational structure. Physiotherapists’ skills should be reinforced with training dedicated to communication-relational aspects and supported by assessment tools necessary to screen and evaluate psychosocial factors. As regards organizational structure, it takes the opportunity to design a clinical path or structure specialized in outpatient services for patients with chronic low back pain (CLBP). Conclusion: Some results are aligned with the literature. In particular, the need to reinforce physiotherapists’ inter-relational skills and to support them with the intervention of other specialists (multidisciplinary team) in the case of problems not strictly of their competence. The role of management is to identify organizational solutions to creating clinical pathways to reduce dispersion and to reinforce the professionals’ expertise